Progressive destruction of alveolar walls, which leads to chronic hyperinflation and expansion. “pink puffers”. Can result from genetic abnormalities in the alpha-antitripsin. o Destruction of alveoli walls leads too: decreased surface area of respiration, destruction of pulmonary capillaries; ischemia, destruction of elastic properties, destruction of surrounding structures; bronchioles, fibrosis and hypertrophy of bronchial walls; decreased capacity to remove secretions, restricted airways, decreased efficiency of expiration, flattened diaphragm, chronic CO2 retention, dyspnea, increased use of accessory muscles; increased fatigue, cor pulmonae. o Clinical manifestations: forward flexed posture, high anxiety, SOA, clubbed fingers, barrel chest shape, chronic cough; usually dry, wheezing/crackles, cyanosis.